Congestive jejunopathy in portal hypertension.

Nagral, Aabha; Joshi, Adarsh; Bhatia, Shobna; Abraham, Philip; Mistry, F P; Im, Vora

doi:10.1136/gut.34.5.694

Cited by 75 publications

(46 citation statements)

References 20 publications

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“…In fact, McCormack et al [6], in 1985, were the first to describe the entity called congestive gastropathy, but similar changes were later reported to occur also in the duodenum [15,20,21] and large bowel [3,4,[11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

“…Congestive gastroenteropathy has been reported to be a non-variceal cause of bleeding in patients with PTH [15,20], but most of the studies on portal hypertensive enteropathy (PHE) found in the literature were obtained by upper endoscopy [15,20], by push enteroscopy [22], or by retrograde ileoscopy at colonoscopy [23,24], and only include the duodenum, proximal jejunum, and terminal ileum.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Portal Hypertension in the Small Bowel: An Endoscopic Approach

et al. 2007

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Background and aim The effects of portal hypertension in the small bowel are largely unknown. The aim of the study was to prospectively assess portal hypertension manifestations in the small bowel. Methods We compared, by performing enteroscopy with capsule endoscopy, the endoscopic findings of 36 patients with portal hypertension, 25 cirrhotic and 11 non-cirrhotic, with 30 controls. Results Varices, defined as distended, tortuous, or saccular veins, and areas of mucosa with a reticulate pattern were significantly more frequent in patients with PTH. These two findings were detected in 26 of the 66 patients (39%), 25 from the group with PTH (69%) and one from the control group (3%) (P \ 0.0001). Among the 25 patients with PTH exhibiting these patterns, 17 were cirrhotic and 8 were non-cirrhotic (P = 0.551). The presence of these endoscopic changes was not related to age, gender, presence of cirrhosis, esophageal or gastric varices, portal hypertensive gastropathy, portal hypertensive colopathy, prior esophageal endoscopic treatment, current administration of beta-blockers, or Child-Pugh Class C. More patients with these endoscopic patterns had a previous history of acute digestive bleeding (72% vs. 36%) (P = 0.05). Active bleeding was found in two patients (5.5%). Conclusions The presence of varices or areas of mucosa with a reticulate pattern are manifestations of portal hypertension in the small bowel, found in both cirrhotic and non-cirrhotic patients. The clinical implications of these findings, as regards digestive bleeding, are uncertain, although we documented acute bleeding from the small bowel in two patients (5.5%).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of Portal Hypertension in the Small Bowel: An Endoscopic Approach

et al. 2007

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“…Misra [2] found a significant decrease in villus/crypt ratio in cirrhotic patients when compared to healthy volunteers. On the other hand, Nagral [22] reports a significant number of patients with large vessels in duodenal mucosa of patients with portal hypertension in comparison with controls, but did not find a statistical difference in severity and type of infiltrate, edema of lamina propria or villus/crypt ratio between the groups. In the study of Barakat [5] , abnormal villus changes were present in 11.4% of portal hypertensive patients.…”

Section: Discussionmentioning

confidence: 97%

Histological abnormalities of the small bowel mucosa in cirrhosis and portal hypertension

Wakim-Fleming¹,

Zein²,

Bennett³

et al. 2008

WJG

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INTRODUCTIONStudies of small bowel (SB) mucosa in cirrhosis and portal hypertension report a diverse spectrum of histological abnormalities [1][2][3][4][5] . These include increased capillary angiogenesis, mucosal edema, decreased villus to crypt ratio, villus atrophy and decreased total absorptive surface. Villus abnormalities resemble the abnormalities of coeliac disease (CD) and this may affect the interpretation of small bowel biopsy, and lead to confusion when CD is to be excluded in patients with cirrhosis and portal hypertension.The diagnosis of CD is increasingly considered and work up recommended during the evaluation of abnormal liver enzymes [6][7] . This is in part due to the heightened awareness of the association of CD with a variety of liver disorders. Most commonly described associated liver disorders include autoimmune hepatitis, primary biliary cirrhosis, non-alcoholic fatty liver disease, unexplained abnormal liver tests and cirrhosis [8][9][10][11][12][13][14][15] . The mechanisms of this association are not clear and the prevalence of CD in patients with liver disease is variable depending on the associated liver disease. For example, while CD affects 1% of the general population, one study reports that about 4% of 185 cirrhotic patients who had undergone liver transplantation were found to have CD, and 3 of 4 pa- Abstract AIM: To study the small bowel (SB) mucosa on biopsy in cirrhotic patients with portal hypertension and in non-cirrhotic controls and grade findings according to the Marsh criteria. METHODS: We prospectively enrolled 51 consecutive patients undergoing an upper endoscopy for their routine medical care. Twenty five patients with cirrhosis and portal hypertension were compared to 26 controls. We obtained coeliac serology and multiple upper small bowel biopsies on all 51 patients. A GI pathologist interpreted biopsies and graded findings according to the Marsh criteria. We assessed equivalence in Marsh grade between cirrhotic and non-cirrhotic controls using the Mann-Whitney test for equivalence. RESULTS: Gender, ethnicity and age were similar between both groups. Marsh grades were equivalent between the groups. Grade of 0 was present in 96% and grade of 1 was present in 4% of both groups and there was no villus atrophy or decrease in villus/crypt ratio in patients with portal hypertension. CONCLUSION: This study provides evidence for the lack of villus atrophy in patients with cirrhosis and portal hypertension, and supports the continuous reliance on the Marsh criteria when the diagnosis www.wjgnet.comWakim-Fleming J et al . Cirrhosis with portal hypertension does not cause atrophy of the small bowel mucosa 6371

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“…Chronic inflammatory infiltration found in the small bowel predominantly consists of mononuclear cells, and it is accompanied by atrophy, a decreased villous/crypt ratio, edema of the lamina propia, fibromuscular proliferation, and thickened muscularis mucosa [70,71]. Since most of the aforementioned characteristics can be explained on the basis of increased levels of mast cell me diators [72], these cells could be involved in the pathogenesis of portal hypertensive chronic enteropathy [35,36].…”

Section: The Angiogenic Phenotype: Remodeling Through Extraembryonic mentioning

confidence: 99%

Portal hypertension-related inflammatory phenotypes: From a vitelline and amniotic point of view

Aller¹,

Arias²,

Prieto³

et al. 2012

ABB

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Prehepatic portal hypertension induces a splanchnic low-grade inflammatory response that could switch to high-grade inflammation with the development of severe and life-threatening complications when associated with chronic liver disease. The extraembryonic origin of the portal system maybe determines the regression to an extraembryonic phenotype, i.e., vitellogenic and amniotic, during the evolution of both types of portal hypertension. Thus, prehepatic portal hypertension, or compensated hypertension by portal vein ligation in the rat, is associated with molecular mechanisms related to vitellogenesis, where hepatic steatosis and splanchnic angiogenesis stand out. In turn, extrahepatic cholestasis in the rat induces intrahepatic portal hypertension, or decompensated hypertension, with ascites and hepatorenal syndrome. The splanchnic interstitium, the mesenteric lymphatic system, and the peritoneal mesothelium seem to create an inflammatory pathway that could have a key pathophysiological relevance in the production of ascites. The hypothetical comparison between the ascitic and the amniotic fluid also allows for translational investtigation. The induced regression of the splanchnic system to extraembryonic functions by portal hypertension highlights the great relevance of the extraembryonic structures even during post-natal life.

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Congestive jejunopathy in portal hypertension.

Cited by 75 publications

References 20 publications

Effect of Portal Hypertension in the Small Bowel: An Endoscopic Approach

Effect of Portal Hypertension in the Small Bowel: An Endoscopic Approach

Histological abnormalities of the small bowel mucosa in cirrhosis and portal hypertension

Portal hypertension-related inflammatory phenotypes: From a vitelline and amniotic point of view

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